EP215: Humanizing Dermatopathology: Embracing Error with Compassion

Failure, Error, and Self-Compassion in Dermatopathology: Lessons from Dermpedia

This episode of The Girl Doc Survival Guide shares reflections after Dr. Artur Zembowicz’s Dermpedia course in Boston on failure, mistakes, and improving in dermatopathology. Dr. Zembowicz emphasizes being prepared to fail when starting new ventures and notes that sports can build resilience by exposing people to stronger competitors. Dr. Alejandro Gru argues that error is intrinsic and unavoidable, encourages careful, unrushed case review, open discussion of mistakes with clinicians, seeking second opinions, learning from errors, and moving forward without becoming paralyzed—especially when patient management may be affected. Dr. Philip LeBoit challenges the “aura of infallibility” expected of experts and stresses balancing best effort with honesty. Dr. Yu Tse Heng explains other compassion and self-compassion as noticing suffering, empathizing/common humanity, and acting with kindness, noting small practices can strengthen both.

00:00 Welcome and Course Highlights

00:56 Meet Dr Zembowicz

01:31 Embracing Failure to Innovate

02:20 Meet Dr Gru

02:39 Handling Errors and Feedback

04:31 Recovering and Improving After Mistakes

05:33 Meet Dr LeBoit

06:06 Experts Aren’t Infallible

06:41 Self Compassion at Work

08:54 Practicing Compassion Daily

10:09 Final Takeaways and Thanks

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide, a compilation of thoughts from three experts in dermatopathology, focusing on failure, making mistakes, and dealing with it and learning to be better. I recently came back from a trip to Boston where I was honored to participate in Dr. Artur Zembowicz's Dermpedia course and wanted to highlight some of the thoughts from Dr. Artur Zembowicz, Dr. Alejandro Gru, and Dr. Phillip LeBoit, all three of whom were also speaking at this course. Please do consider joining Dermpedia if you're a pathologist or dermatopathologist. There's a lot of great content there that Dr. Zembowicz has made great efforts to make available.

Dr. Artur Zembowicz, MD, PhD, is the founder, [00:01:00] medical director and principal consultant at Dermatopathology Consultations, LLC, and the founder of dermpedia.org. He is also a Professor of Anatomic and Clinical Pathology at Tufts Medical School and a Senior Dermatopathology Consultant at Lahey Clinic in Burlington, Massachusetts. Dr. Zembowicz is an innovator in dermatopathology education and is always pushing the envelope to do better in education. In so doing, he recognizes that there will be failures. Here is Dr. Zembowicz.

Artur Zembowicz: For new things, if you want to start new things, what is very helpful is to be prepared to fail. And that's very difficult for many people. And that is that this audacity to try to put a shingle out. I was very fortunate myself that I have no really fear of failure. If I fail, it really doesn't bother me. Really. And I don't feel that other people perceive it as failure, so it's [00:02:00] easier for me in in, in that sense. I think, what really helps is sports because you in sports, you always have going to have a better competitor than you. I think it's good to have that experience.

Christine Ko: In addition to failures, when we try new things, the daily practice of dermatopathology, or really anything, can lead to errors. Dr. Alejandro Gru, MD, is the Leonard C. Harber Professor of Dermatology and Director of Dermatopathology at Columbia University Irving Medical Center. He was previously at the University of Virginia, where he was Professor of Pathology and the Dermatopathology Section and Fellowship Program Director. Here is Dr. Gru.

Ale Gru: I think error is unavoidable in what we do. No matter what we do, you have to face and accept the fact that you're gonna make errors no matter how careful, conscientious, or good you are. It doesn't matter. Error is intrinsic [00:03:00] to what we do. I think it's important to accept the fact first that you're going to make mistakes. And that you're going to get that dreadful call that the clinician wants to talk to you about the case. And then you pull out the case and it's, Dang... Try to be careful, be mindful, be respectful of the time you want to spend with each case that you're looking at. Try not to rush through things. But at the same time, when you make a mistake, and you see you've made a mistake, I think it's so important that you discuss with whoever the person is, when you have made a mistake and tell them, Listen, I looked at this case, and I thought so and so, but now I'm looking at this again, and I can see your point and et cetera. I think a lot of people feel afraid about that level of interaction and thinking, Oh, this person thinks I'm not very smart, and how come that I made my mistake or et cetera, but really the fact is that when you have those conversations, the people [00:04:00] usually face it very well. Of course, there's a lot of different personalities that have to be involved in that. But I do think that whenever you have those conversations, you learn a lot from discussing with the person, and usually the outcome is very good. When you aren't sure about something, show your cases to other colleagues or just send the case out for a second opinion. But at the end of the road, you have to accept that no matter how best you think you're trying, there's still mistakes going to be made.

It is failure. And I think it is hard to swallow it when you see that you've made a mistake.

And of course it matters the most when it's something that potentially can change the management for a patient. You feel bad about it. And then say, okay, I'm going to try. How can I make this particular error better? How can I try to improve for the next time? Just thinking about alternative ways of how you can make it different or [00:05:00] how you can make it better makes you feel a little bit better and try to improve it as much as you can.

You cannot get fixed into mistakes, no matter how bad they are. Of course, the mistake is bad. That makes you feel worse, and you take a little bit more time to recover. But to me, it's just, okay, I need to move on. There's a lot of things that needs to be finished. Otherwise, it almost paralyzes you and can't move on with my life and my career. I accept the fact that no matter what I know I'll be making mistakes.

Christine Ko: We are all only human, and everyone makes mistakes. Dr. Philip LeBoit is Professor of Pathology and Dermatology as well as Division Chief of the Dermatopathology Service at the University of California, San Francisco. He founded the UCSF dermatopathology and oral pathology service in 1987. He has written several academic textbooks, including one of my favorites with Dr. Guido Massi, Histologic Diagnosis of Nevi and Melanoma. He was Editor in Chief of the American Journal of Dermatopathology from 1997 to [00:06:00] 2006, and an Associate Editor of the Journal of Investigative Dermatology. As Dr. LeBoit says,

Philip LeBoit: Especially if you're at a level where you're getting consultations from other people, having an aura of infallibility is sort of part of the game that everybody plays. And it's just not true that experts are infallible. And I wanna be honest about it.

Christine Ko: There is a necessary balance between doing our very best and also being compassionate with ourselves when we make mistakes because honesty with ourselves and those around us, and being able to communicate that honesty well and with self-compassion is important. I am reminded of my conversation with Dr. Yu Tse Heng, who has done research in self-compassion, other compassion, and humanizing the workplace. Dr. Yu Tse Heng, PhD is an Assistant Professor at the University of Virginia McIntire School of Commerce. She [00:07:00] received her PhD in Organizational Behavior from the University of Washington Foster School of Business. Her research program uncovers ways in which we can humanize the workplace. Her work has also been featured in media outlets such as The New York Times, the Financial Times, and CNBC Make It.

Yu Tse Heng: Other compassion is this three step process of us noticing another person suffering, empathizing, and then acting in ways to alleviate this person's suffering. So for example, you could see that coworker's just going through a divorce, having a really hard time. You empathize, and you act in ways to alleviate their suffering by listening, giving them a hug, and so on. Self-compassion is something we are less comfortable with and we are more awkward about. But it really is compassion, that we usually direct outwards, inwards, right? So it's about us giving ourself that compassion that we so regularly give other people, right? So self-compassion is also this three step process of us first noticing our own suffering. Really mindfully aware [00:08:00] that we're going through hard times. It's very painful. It's about us also understanding this idea of common humanity. So, we are going through a hard time. We're dealing with this issue, but everyone else also has these issues that they have to deal with from time to time. The last part of self-compassion is really self-kindness, which is us acting in ways to alleviate our own suffering, right? So an example could be that here I went to work today and had a really hard time dealing with a patient, and I feel like I didn't do well enough. And self-compassion will mean that, Hey I'm gonna acknowledge that I'm having these negative feelings. I'm not gonna over-identify with them. I'm going to remind myself that this is not something that only I experience. This is something that everyone else goes through from time to time as well. It's just the nature of the job. Then the final step is to really act in ways to alleviate your suffering, pain, guilt and so on. That could be engaging in a self-care activity that you enjoy. It could be going swimming, gardening, something that fuels your cup, right?

Being kind to other people seems easier or seems more intuitive, just because we have done it more [00:09:00] often. Self-compassion is something that's harder for people to do just because it's something that people have not really thought about for a long time. The good thing about these two things, these two different constructs, and these two exercises or approaches, is that when you try to be better at one, you tend to be better at the other.

When we take the time to notice, to get attuned to other people's feelings, and to empathize, and to act, we are using the same muscles that we can also use towards ourselves. So that's really just a focus kind of thing. One thing about compassion is that it doesn't really have to take a lot of effort, like humanizing the workplace. It doesn't have to be a 30 minute session with someone. It could simply be a hug or just being present. And I think the same goes for self-compassion where you don't have to go for a self-compassion, like eight week mindfulness course or something like that to be self-compassionate. It could just be like a five minute mindfulness meditation, just taking the time to pause and to be kind to ourselves and to other people.

Christine Ko: So if possible, [00:10:00] work your muscle of self-compassion in order to also be working your muscles for other compassion and help everyone. And let's keep in mind no one is immune to failure and error. Thank you for listening in. Please consider subscribing and sharing this podcast as well. Thank you.